Troches are a specific type of medication designed for absorption in the mouth. This delivery method offers benefits for various medical needs, distinguishing troches from traditional pills or liquids.
Defining Troche Medication
A troche is a small, solid dosage form designed to dissolve slowly in the mouth. Unlike tablets or capsules that are swallowed, troches are meant to release their active ingredients gradually as they melt, similar to lozenges or cough drops in their physical form and slow dissolution. Troches are typically made from a medicinal substance combined with a base. They can be flavored to improve taste, which is particularly useful for medications that might otherwise be unpleasant. Many troches are prepared by compounding pharmacies, allowing for customized dosages and combinations of medications.
How Troches Deliver Medication
Troches deliver medication through oral mucosal absorption, primarily via buccal and sublingual routes. When placed in the mouth, either between the cheek and gum (buccal) or under the tongue (sublingual), the medication dissolves and is absorbed directly into the bloodstream through the rich network of blood vessels in these areas. This method bypasses the digestive system and the liver, which is a significant advantage as it avoids “first-pass metabolism.” In first-pass metabolism, orally swallowed medications are processed by the liver before entering general circulation, which can reduce the amount of active drug available to the body. By avoiding this, troches can lead to higher bioavailability, meaning more of the medication reaches the bloodstream in its active form, and can also result in a faster onset of action for some drugs compared to those taken orally.
Diverse Applications of Troches
Troches are used for a variety of conditions, particularly when bypassing the digestive system or addressing local oral issues is beneficial. A common application is in hormone replacement therapy (HRT), where hormones like estrogen, progesterone, and testosterone are delivered to ensure efficient absorption and stable levels, and this method is often preferred for hormones that can be significantly metabolized if swallowed. Pain management is another area where troches are frequently employed, providing localized relief or systemic effects for moderate to severe pain. Medications for nausea and vomiting can also be formulated as troches, offering an alternative for patients who might struggle to keep down oral pills. Additionally, troches are useful for patients who have difficulty swallowing, including children and the elderly.
Patient Guidance for Troche Use
Proper administration of a troche is important for its effectiveness. The medication should be placed in the mouth, either under the tongue or between the cheek and gum, as directed by a healthcare provider. It is important to allow the troche to dissolve slowly over a period; chewing, swallowing whole, or crushing the troche should be avoided, as this can prevent proper absorption. Patients should avoid eating or drinking for at least 15 to 30 minutes after the troche has completely dissolved to ensure maximum absorption. Rotating the placement of the troche within the mouth each time it is used can help improve absorption and prevent irritation. Troches should be stored in a cool, dry place, away from light, and should not be left in warm environments like a car, as they can melt.